References

Nosokinetics

Miscellaneous References

Focusing on cost of care

Chronic Care Model reduces cost and LOS in COPD
Adams, S. G., P. K. Smith, et Al. "Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management." Archives of Internal Medicine 167, no. 6(2007): 551-61
A 2005 literature review of found no significant differences in symptoms, quality of life, lung function, and functional status between the intervention and control groups. However, the group with two or more interventions had fewer emergency/unscheduled visits and hospitalizations and a shorter length of stay compared with control groups.

A&E (ed): Severity of illness increases cost

Dong, S. L., M. J. Bullard, et Al "Predictive validity of a computerized emergency triage tool." Academic Emergency Medicine 14, no. 1(2007): 16-
eTRIAGE, a web-based decision support tool, is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent). During a six month period, 29,524 patients were triaged. The odds ratio (p<0.001) for admission, and costs were greater in CATS 1 and 2 compared with 4 and 5. and CATS 1 were more likely to die, which given the nature of illness is not unexpected.

Cardiac Surgery: Adverse events increase cost

Ehsani, J. P., S. J. Duckett, and T. Jackson. "The incidence and cost of cardiac surgery adverse events in Australian (Victorian) hospitals 2003-2004." Eur J Health Econ
Linear regression modelling, adjusted for age and co-morbidity was used. 36.8% of 16,766 multi-day cardiac disease cases had at least one adverse event. They stayed approximately 7 days longer and had four times the case fatality rate. The total cost of adverse events for each DRG was AUS$42.8 million, representing 21.6% of total expenditure on cardiac surgery and adding 27.5% in broad terms to the cardiac surgery budget.

Academic Teams decrease cost of care

Everett, G., N. Uddin, and B. Rudloff. "Comparison of hospital costs and length of stay for community internists, hospitalists, and academicians." Journal of General Internal Medicine 22, no. 5(2007): 662-
This single institution retrospective cohort study reports that academic Internist teams had lower cost and LOS compared to traditional private Internists (30% and 40%) and private Internists (24% and 30%). Hospital mortality was equivalent for all groups. Academic teams had 2.3-2.6% more 30-day readmissions than the other groups.

Life style influences outcome

Burke, V., Y. Zhao, et Al. "Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines." Preventive Medicine 44, no. 2(2007): 135-
A 1988-89, survey of Western Australian Aborigines (256 women, 258 men) aged 15-88 years documented their diet, alcohol and smoking habits. A longitudinal study using 2002 data and Cox regression found clustering of adverse behaviours is common and increases the risk of coronary heart disease and death.

Modelling Pathways

Adeyemi, S., T. Chaussalet, H. Xie, and P. Millard (2007) Patients Flow: A Mixed-Effects Modelling Approach to Predicting Discharge Probabilities, pp. 725-730
A class of generalized linear mixed models is used to capture individual patients experience during the process of care as represented by their pathways through the system. The approach could predict the probability of discharge from the system, as well as detect where the system may be going wrong.

A&E Unintended consequences

Han, J. H., C. Zhou,et Al. "The effect of emergency department expansion on emergency department overcrowding." Academic Emergency Medicine 14, no. 4(2007): 338-43
An increase in ED bed capacity did not affect ambulance diversion. Instead, total and admission hold LOS increased. As a result, ED expansion appears to be an insufficient solution to improve diversion without addressing other bottlenecks in the hospital.

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